The more liberal attitude towards sexually related problems in the western world has been one reason for the increased public interest in the subject of sexual impotency.
Impotency is a lack of copulative power. Potency is dependent on the following factors:
1. Libido
2. Erection
3. Ejaculation
4. Orgasm
The mechanism of coitus starts with libido and erection and terminates with ejaculation and orgasm. There are three types of impotency in the human male: the first being erectile, the second, ejaculatory; and the third, premature ejaculatory. The causes which bring about impotency are broadly speaking functional or organic or a combination of the two. In fact, organic causes are almost always accompanied by functional causes since the mechanism of erection and the mechanism of ejaculation are mediated via a complex group of peripherally and centrally controlled reflexes. The least trauma to the nerves supplying the muscles involved in erection or ejaculation may result in non-effectual function.
Organic causes include local pathologic conditions of the male genitalia, acute and systemic diseases such as chronic alcoholism or anemia and diseases of the nervous system such as diseases of the brain and spinal cord. Functional causes include many different types of psychoneuroses.
One of the types of male impotency that has been successfully helped by surgical management is erective impotency. Erective impotency is the persistant inability to obtain or maintain a penile erection sufficient to allow orgasm and satisfactory ejaculation during heterosexual coitus. Erective impotency may have organic causes such as diabetes or functional causes such as psychoneurosis.
The justification of a surgical approach to the correction of psychological impotency lies in the problems related to the psychotherapeutic treatment of the patient with absolute impotency with one or more years duration. The patient who consults a psychiatrist for treatment presents the highest failure rate; if the patient achieves some degree of success after prolonged psychotherapy, he is likely to revert to his impotent state with the usual social and business stresses and, of course, with his first failure to achieve an erection, will tend to fail again. Impotency, in many of these cases, is such an overriding symptom that the necessity of curing the symptom (i.e., the impotency) is necessary before the underlying psychoneurosis can be reached. There seems to be a general feeling that if the impotency can be corrected, many of the psychoneurotic manifestations, which are a function of transference after the patient discovers he is impotent, would be self resolving. Surgical correction of the impotency will allow the therapist greater success with the psychoneurotic problems that cause the impotence.
For many years, external rubber or plastic dildos have been used to either provide or support an erection. The short comings of such external prosthesis are discomfort and the lack of penile skin contact with the vaginal mucosa. The first successful penile reconstruction, by Sir Harold Gillies, in 1957, utilized a cartilage graft brace. An unsuccessful use of an acrylic rod, as a brace, was made by Goodwin and Scott in the early 1950's. The use of cartilage or bone as an implant is not satisfactory because the materials are absorbed either in part or totally. The idea of an os penis led Loeffler, Sayegh, and Lash, in 1964, to implant an acrylic rod between the corpora cavernosa. G. E. Beheri, in 1966, disclosed the use of polyethylene rods implanted into the center of each of the corpora cavernosa as an aid to overcoming impotency. A t-shaped prosthesis has been fitted between the corpora cavernosa with a crossbar butted against the pubic bone. The patent to Kalnberz, U.S. Pat. No. 3,832,996, issued Sept. 3, 1974, discloses an endo-prosthesis for the penis which is yoke-like in configuration having a portion of the arms immersed in the cavernous bodies near the glans. In the paperback book entitled Self-Image Surgery by Maxine Mesinger at page 142, there is a perspective drawing of a penile implant which resembles in some respects the inventor's implant. This disclosed implant, however, has a shoulder located approximately one-third back from the dorsal end. Furthermore, both the dorsal and proximal ends are notched. Also, the upper surface of the implant is arced while that of the inventor's is planar throughout.